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• Rf. 4021-10 (4/73) <br /> RTASR Or COLORADO <br /> RLTA*TMENT or RIUMUll <br /> APPLICATION ADDE1i1XAi* FOR A LtQgct LICE= <br /> Teix Appltcation Adc.'rruitao nruet he filled out empletety and filed with Cut <br /> Application. <br /> No license wilt be issued until the Application and the Application Addendum <br /> has boon approved by the respective Licensing Authorities. <br /> All Answers lust le Printed In Ink or Typewritten. <br /> 1. Nark of Appl scant(s) • - • <br /> • ail w . • , , . . <br /> Business Tel. No. jr - <br /> 2. Trade Name <br /> 3. Address of place to be licensed <br /> 4. City or Town 41.0 1 lie,. - County- 4 A! r <br /> S. Do you have legal possession of the premises? y <br /> 6. Are the premises owned or rented? If renttd,from whom? 6lLaa / . /t.J.c <br /> 7. effective date of the lease, 7 f 70j,� •,, ,_- .Expires -�- / <br /> 3. Do you or any members of your Jame..y have • direct or indirect interest in any Giber <br /> Colorado Liquor License? (Such interest include any interest, loan, etc.) If the <br /> answer is yea, explain in details Yes - No "r - <br /> 9. Does any person, partnership, firm, have any interest (financially or other) tither <br /> by loans or equity ownership in the business for which this license is requested? If <br /> the answer is yes, state names end addresses and amount of such (financial) interest <br /> Yes - No ✓ <br /> (he fmllowing affidavit to be signed and stknowledged by individuals and each member of <br /> partnerships or tiros) <br /> STATE; COLORADO <br /> Count •f <br /> and . '' ;,.., 4s.4..0,, being by see first du y sworn if for himself, deposes <br /> and says; that t is th ' applicant above mimed; or that he is of the <br /> above named corporation; that he has read the foregoing application and that he knows <br /> the contents thereof, and that all scatters and things therein act forth are true of his <br /> ova knowledge and he agrees to conform to all rules and regulations promulgated by the <br /> State Department of Revenue in connection therewith. <br /> Subscribed and sworn to before me individuals and all members of partnership <br /> or fi . must sign here: <br /> this 1/, day of - _ . ,:__cmin <br /> (Sii;naturc of otary Public) <br /> Actftek .$eal <br /> • <br /> • <br /> t;y Ccrr.la3Lon Expires r'y C ni 'ors xpiroe 44,141.0 4. iqrl <br />